ObjectiveThe association between proton pump inhibitor (PPI) use and gastric cancer related to Helicobacter pylori eradication has not been fully investigated in geographical regions with high risk ...of gastric cancer. We aimed to evaluate the association between PPIs and gastric cancer in Korea.DesignThis study analysed the original and common data model versions of the Korean National Health Insurance Service database from 2002 to 2013. We compared the incidence rates of gastric cancer after 1-year drug exposure, between new users of PPIs and other drugs excluding PPIs, by Cox proportional hazards model. We also analysed the incidence of gastric cancer among PPI users after H. pylori eradication.ResultsThe analysis included 11 741 patients in matched PPI and non-PPI cohorts after large-scale propensity score matching. During a median follow-up of 4.3 years, PPI use was associated with a 2.37-fold increased incidence of gastric cancer (PPI≥30 days vs non-PPI; 118/51 813 person-years vs 40/49 729 person-years; HR 2.37, 95% CI 1.56 to 3.68, p=0.001). The incidence rates of gastric cancer showed an increasing trend parallel to the duration of PPI use. In H. pylori-eradicated subjects, the incidence of gastric cancer was significantly associated with PPI use over 180 days compared with the non-PPI group (PPI≥180 days vs non-PPI; 30/12 470 person-years vs 9/7814 person-years; HR 2.22, 95% CI 1.05 to 4.67, p=0.036).ConclusionPPI use was associated with gastric cancer, regardless of H. pylori eradication status. Long-term PPIs should be used with caution in high-risk regions for gastric cancer.
Background and Aim
Association between protonpump inhibitors (PPIs) and osteoporosis, hip fractures has not been fully elucidated. We aimed to evaluate the relationship between PPIs use and the risk ...of osteoporosis and hip fractures in the databases converted to a common data model (CDM) and to compare the results across the databases.
Methods
This was a population‐based, propensity‐matched, retrospective cohort study that included patients aged ≥ 50 years who were prescribed with PPIs for over 180 days. We compared the incidence of osteoporosis and hip fractures between new PPI user and new user of other drugs using the Cox proportional hazards model and performed meta‐analysis in the electronic health record (EHR) databases.
Results
In the Korean National Health Insurance Service (NHIS)–CDM database, long‐term PPI users had greater risk of osteoporosis PPIs vs non‐PPIs groups, 28.42/1000 person‐years vs 19.29/1000 person‐years; hazard ratio (HR), 1.62; 95% confidence interval (CI), 1.22–2.15; P = 0.001. The meta‐analytic results of six EHR databases also showed similar result (pooled HR, 1.57; 95% CI, 1.28–1.92). In the analysis of hip fracture, PPI use was not significantly associated with a hip fracture in the NHIS–CDM database (PPI vs non‐PPI groups, 3.09/1000 person‐years vs 2.26/1000 person‐years; HR, 1.45; 95% CI, 0.74–2.80; P = 0.27). However, in the meta‐analysis of four EHR databases, the risk of hip fractures was higher in PPI users (pooled HR, 1.82; 95% CI, 1.04–3.19).
Conclusions
Long‐term PPI was significantly associated with osteoporosis; however, the results of hip fractures were inconsistent. Further study based on better data quality may be needed.
This observational study explored the association between proton pump inhibitor (PPI) and histamine-2 receptor antagonist (H2RA) use and the risk of chronic kidney disease (CKD). Using the National ...Health Insurance Service-National Sample Cohort (NHIS-NSC) and six-hospital electronic health record (EHR) databases, CKD incidence was analyzed among PPI and H2RA users. Propensity score matching was used to balance baseline characteristics, with 1,869 subjects each in the PPI and H2RA groups from the NHIS-NSC, and 5,967 in EHR databases. CKD incidence was similar for both groups (5.72/1000 person-years vs. 7.57/1000 person-years; HR = 0.68; 95% CI, 0.35-1.30). A meta-analysis of the EHR databases showed no significant increased CKD risk associated with PPI use (HR = 1.03, 95% CI: 0.87-1.23). These results suggest PPI use may not increase CKD risk compared to H2RA use, but the potential role of PPI-induced CKD needs further research. Clinicians should consider this when prescribing long-term PPI therapy.
The purpose of this study was to investigate complications and radiologic and clinical outcomes of medial opening wedge high tibial osteotomy (MOWHTO) using a locking plate.
This study reviewed 167 ...patients who were treated with MOWHTO using a locking plate from May 2012 to June 2014. Patients without complications were classified into group 1 and those with complications into group 2. Medical records, operative notes, and radiographs were retrospectively reviewed to identify complications. Clinically, Oxford Knee score and Knee Injury and Osteoarthritis Outcome score (KOOS) were evaluated.
Overall, complications were observed in 49 patients (29.3%). Minor complications included lateral cortex fracture (15.6%), neuropathy (3.6%), correction loss (2.4%), hematoma (2.4%), delayed union (2.4%), delayed wound healing (2.4%), postoperative stiffness (1.2%), hardware irritation (1.2%), tendinitis (1.2%), and hardware failure without associated symptoms (0.6%). Major complications included hardware failure with associated symptoms (0.6%), deep infection (0.6%), and nonunion (0.6%). At the first-year follow-up, there were no significant differences in radiologic measurements between groups 1 and 2. There were no significant differences in knee scores except for the KOOS pain score.
Our data showed that almost all complications of the treatment were minor and the patients recovered without any problems. Most complications did not have a significant impact on radiologic and clinical outcomes.
Although the incidence of inflammatory bowel disease IBD is increasing in Asia, data on long-term epidemiological trends are limited. We performed a 30-year longitudinal study to investigate temporal ...trends in the epidemiology of Crohn's disease CD and ulcerative colitis UC in Seoul, Korea.
This population-based study included 1431 IBD patients 418 CD, 1013 UC diagnosed between 1986 and 2015 in the Songpa-Kangdong district of Seoul, Korea. Temporal trends in incidence, prevalence, and disease phenotype at diagnosis were analysed.
The adjusted mean annual incidence rates of CD and UC per 100 000 inhabitants increased from 0.06 (95% confidence interval CI, 0.05-0.07) and 0.29 95% CI, 0.27-0.31, respectively, in 1986-1990 to 2.44 95% CI, 2.38-2.50 and 5.82 95% CI, 5.73-5.92, respectively, in 2011-2015. Average annual percentage change in IBD incidence was 12.3% in 1986-1995, 12.3% in 1996-2005, and 3.3% in 2006-2015. The male-to-female ratio of the adjusted incidence rate was 3.3:1 for CD and 1.2:1 for UC. Perianal fistula/abscess was present in 43.3% of patients before or at CD diagnosis. At diagnosis, 54.3% of UC patients presented only with proctitis. The adjusted prevalence rate in 2015 was 31.59/100 000 95% CI, 31.10-32.07 for CD and 76.66/100 000 95% CI, 75.91-77.42 for UC.
The incidence and prevalence of IBD in Korea have continued to increase over the past three decades. Korean patients have distinct demographic and phenotypic characteristics, including a male predominance and high frequency of perianal fistula/abscess in CD and high proportion of proctitis in UC.
Statin treatment increases the risk of new-onset diabetes mellitus (NODM); however, data directly comparing the risk of NODM among individual statins is limited. We compared the risk of NODM between ...patients using pitavastatin and atorvastatin or rosuvastatin using reliable, large-scale data.
Data of electronic health records from ten hospitals converted to the Observational Medical Outcomes Partnership Common Data Model (n = 14,605,368 patients) were used to identify new users of pitavastatin, atorvastatin, or rosuvastatin (atorvastatin + rosuvastatin) for ≥ 180 days without a previous history of diabetes or HbA1c level ≥ 5.7%. We conducted a cohort study using Cox regression analysis to examine the hazard ratio (HR) of NODM after propensity score matching (PSM) and then performed an aggregate meta-analysis of the HR.
After 1:2 PSM, 10,238 new pitavastatin users (15,998 person-years of follow-up) and 18,605 atorvastatin + rosuvastatin users (33,477 person-years of follow-up) were pooled from 10 databases. The meta-analysis of the HRs demonstrated that pitavastatin resulted in a significantly reduced risk of NODM than atorvastatin + rosuvastatin (HR 0.72; 95% CI 0.59-0.87). In sub-analysis, pitavastatin was associated with a lower risk of NODM than atorvastatin or rosuvastatin after 1:1 PSM (HR 0.69; CI 0.54-0.88 and HR 0.74; CI 0.55-0.99, respectively). A consistently low risk of NODM in pitavastatin users was observed when compared with low-to-moderate-intensity atorvastatin + rosuvastatin users (HR 0.78; CI 0.62-0.98).
In this retrospective, multicenter active-comparator, new-user, cohort study, pitavastatin reduced the risk of NODM compared with atorvastatin or rosuvastatin.
Background and Aim
Little is known regarding the exact burden of inflammatory bowel disease (IBD) in Asian countries because previous epidemiologic studies were hospital based. We aimed to develop ...and validate an operational definition of IBD cases from health insurance claims data and to examine the epidemiological features of IBD in Korea.
Methods
We analyzed stratified sample data from the Korean Health Insurance Review and Assessment (2010–2016) database using 12 different definitions and applied the best definition to the entire (2007–2016) dataset.
Results
The definition that combined the International Classification of Disease 10th revision code with IBD‐specific medications had the best performance characteristics among the 12 tested definitions. During the 8‐year study period, IBD prevalence increased from 25 345 in 2009 to 47 444 in 2016. Over that period, the prevalence of Crohn's disease increased 1.9‐fold (from 16.0/100 000 in 2009 to 29.6/100 000 in 2016) and that of ulcerative colitis increased 1.6‐fold (from 41.4/100 000 in 2009 to 66.0/100 000 in 2016). Similarly, the estimated incidence of Crohn's disease also increased 1.2‐fold (from 2.4 to 2.9 per 100 000) and that of ulcerative colitis rose 1.3‐fold (from 4.0 to 5.3 per 100 000). During the study period, the predominant increase in IBD incidence was among younger individuals, especially those aged < 30 years.
Conclusion
Patients with IBD can be accurately identified using Korean insurance claims data by combining information regarding the International Classification of Disease 10th revision codes and the IBD medications used. The prevalence of IBD continues to increase, with an apparent shift toward younger (< 30 years) age groups.
ObjectiveNo population-based study has evaluated the natural course of UC over three decades in non-Caucasians. We aimed to assess the long-term natural course of Korean patients with UC in a ...population-based cohort.DesignThis Korean population-based, Songpa-Kangdong IBD cohort included all patients (n=1013) newly diagnosed with UC during 1986–2015. Disease outcomes and their predictors were evaluated.ResultsDuring the median follow-up of 105 months, the overall use of systemic corticosteroids, thiopurines and antitumour necrosis factor (anti-TNF) agents was 40.8%, 13.9% and 6.5%, respectively. Over time, the cumulative risk of commencing corticosteroids decreased, whereas that of commencing thiopurines and anti-TNF agents increased. During follow-up, 28.7% of 778 patients with proctitis or left-sided colitis at diagnosis experienced proximal disease extension. A total of 28 patients (2.8%) underwent colectomy, demonstrating cumulative risks of colectomy at 1, 5, 10, 20 and 30 years after diagnosis of 1.0%, 1.9%, 2.2%, 5.1% and 6.4%, respectively. Multivariate Cox regression analysis revealed that extensive colitis at diagnosis (HR 8.249, 95% CI 2.394 to 28.430), ever use of corticosteroids (HR 6.437, 95% CI 1.440 to 28.773) and diagnosis in the anti-TNF era (HR 0.224, 95% CI 0.057 to 0.886) were independent predictors of colectomy. The standardised mortality ratio in patients with UC was 0.725 (95% CI 0.508 to 1.004).ConclusionKorean patients with UC may have a better clinical course than Western patients, as indicated by a lower colectomy rate. The overall colectomy rate has continued to decrease over the past three decades.
Background:
Dementia has a crucial impact on the quality of life of elderly patients and their caregivers. Proton-pump inhibitors (PPIs) are the most frequently prescribed treatment, but they have ...been shown to be associated with dementia. The data are inconsistent, however.
Objective:
To investigate the association between PPIs use and Alzheimer’s disease (AD) or all-cause dementia in six observational Korean databases using a Common Data Model (CDM) and to perform a distributed network analysis.
Methods:
Subjects aged over 18 years between 1 January 2004 and 31 December 2020. Among 7,293,565 subjects from 6 cohorts, 41,670 patients met the eligibility criteria. A total of 2206 patients who were included in both cohorts or with a history of dementia were excluded. After propensity matching, 5699 propensity-matched pairs between the PPIs and histamine-2 receptor antagonist (H2RA) users were included in this study. The primary outcome was the incidence of AD at least 365 days after drug exposure. The secondary outcome was the incidence of all-cause dementia at least 365 days after drug exposure.
Results:
In the 1:1 propensity score matching, the risk of AD or all-cause dementia was not significantly different between the PPIs and H2RA groups in all six databases. In the distributed network analysis, the long-term PPI users (⩾365 days) were unassociated with AD hazard ratio (HR) = 0.92, 95% confidence interval (CI) = 0.68–1.23; I2 = 0% and all-cause dementia (HR =1.04, 95% CI = 0.82–1.31; I2 = 0%) compared with H2RA users.
Conclusion:
In the distributed network analysis of six Korean hospital databases using Observational Medical Outcomes Partnership (OMOP)-CDM data, the long-term use of PPI was not associated with a statistically significantly increased risk of AD or all-cause dementia. Therefore, we suggest that physicians should not avoid these medications because of concern about dementia risk.
Abstract
Background
The aim of this study is to compare the postoperative analgesic effect of infiltration between the popliteal artery and the capsule of the knee (IPACK) and the effect of ...periarticular multimodal drug injection (PMDI) in addition to adductor canal block (ACB) after total knee arthroplasty.
Methods
Among patients who received total knee arthroplasty from June 2017 to December 2017, 50 who underwent ACB with additional IPACK and 50 who received ACB with additional PMDI were selected for this study. We compared the postoperative pain numerical rating scale (NRS), the number of times patient-controlled analgesia was administered and the amount administered, the total amount of opioids given, and complications associated with the procedure between the two groups.
Results
NRS measured at rest and 45° knee flexion at days 1 and 2 after surgery was significantly lower in the IPACK group than in the PMDI group. The resting NRS measured at day 3 after surgery was also significantly lower in the IPACK group than in the PMDI group, and the NRS at 45° knee flexion measured from day 3 to day 5 showed a significant reduction in the IPACK group. No complications relating to the procedure occurred.
Conclusions
IPACK may be a better option than PMDI for controlling acute phase pain in patients undergoing total knee arthroplasty.
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